Chronic Traumatic Encephalopathy (CTE)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Getting your bell rung was once a badge of honor in sports. The ability to shake it off and not miss a play was accepted and routine. But it had been known for almost a hundred years that repeated hits to the head had long-term consequences and “dementia pugilista” was the term used for a punch drunk old fighter who had been hit in the head one too many times. The realization was slow in coming that the same injury to the brain could occur in football players, and that the most popular sport in the country could be a potential cause of psychiatric disturbances and early dementia.

A new term was born: Chronic traumatic encephalopathy (CTE) describes a gradual degeneration in brain function due to repeated head injuries that causes both concussions with symptoms and concussions that are asymptomatic (do not cause symptoms). Once the initial symptoms of concussion have faded, months and years later, new symptoms occur. CTE symptoms start slowly and creep up on the patient. Initially, there may be concentration and memory problems with episodes of disorientation and confusion, dizziness, and headache. It is as if the concussion symptoms were starting to return even without a new head injury. Emotions get labile and the patient can become aggressive and psychotic. As CTE progresses, behavior becomes even more erratic, with aggression and symptoms similar to those of Parkinson's disease. Finally, thought processes decrease even further, leading to a dementia with more Parkinson's symptoms including speech and walking abnormalities. The symptoms are progressive and cannot be stopped.